Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC TENOTOMY PERCUTANEOUS ADDUCTOR OR HAMSTRING

Facility

$3,641.43

Hospital Charge Code	36000094
Hospital Revenue Code	360
Min. Negotiated Rate	$2,294.10
Max. Negotiated Rate	$3,277.29
Rate for Payer: Aetna Commercial	$3,095.22
Rate for Payer: Aetna New Business (MI Preferred)	$2,366.93
Rate for Payer: Cash Price	$2,913.14
Rate for Payer: Cofinity Advantage	$2,549.00
Rate for Payer: Cofinity Commercial	$3,131.63
Rate for Payer: Encore Health Key Benefits Commercial	$2,913.14
Rate for Payer: Healthscope Commercial	$3,277.29
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,095.22
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,731.07
Rate for Payer: PHP Commercial	$3,095.22
Rate for Payer: Priority Health SBD	$2,294.10

HC TENOTOMY PERCUTANEOUS ADDUCTOR OR HAMSTRING

Facility

$3,641.43

Hospital Charge Code	36000094
Hospital Revenue Code	360
Min. Negotiated Rate	$1,456.57
Max. Negotiated Rate	$3,277.29
Rate for Payer: Aetna Commercial	$3,095.22
Rate for Payer: Aetna Medicare	$1,820.71
Rate for Payer: Aetna New Business (MI Preferred)	$2,366.93
Rate for Payer: BCBS Complete	$1,456.57
Rate for Payer: Cash Price	$2,913.14
Rate for Payer: Cofinity Advantage	$2,549.00
Rate for Payer: Cofinity Commercial	$3,131.63
Rate for Payer: Encore Health Key Benefits Commercial	$2,913.14
Rate for Payer: Healthscope Commercial	$3,277.29
Rate for Payer: MI Amish Medical Board Commercial	$2,913.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,095.22
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,731.07
Rate for Payer: PHP Commercial	$3,095.22
Rate for Payer: Priority Health SBD	$2,294.10

HC TENOTOMY PERCUTANEOUS SINGLE EACH DIGIT

Facility

$4,681.80

Service Code	CPT 26060
Hospital Charge Code	76100424
Hospital Revenue Code	761
Min. Negotiated Rate	$837.96
Max. Negotiated Rate	$5,181.40
Rate for Payer: Aetna Commercial	$3,979.53
Rate for Payer: Aetna Medicare	$1,666.30
Rate for Payer: Aetna New Business (MI Preferred)	$3,043.17
Rate for Payer: Allen County Amish Medical Aid Commercial	$2,002.76
Rate for Payer: Amish Plain Church Group Commercial	$2,002.76
Rate for Payer: BCBS Complete	$879.93
Rate for Payer: BCBS MAPPO	$1,602.21
Rate for Payer: BCBS Trust/PPO	$929.01
Rate for Payer: BCN Commercial	$929.01
Rate for Payer: BCN Medicare Advantage	$1,602.21
Rate for Payer: Cash Price	$3,745.44
Rate for Payer: Cash Price	$3,745.44
Rate for Payer: Cash Price	$3,745.44
Rate for Payer: Cofinity Advantage	$3,277.26
Rate for Payer: Cofinity Commercial	$4,026.35
Rate for Payer: Encore Health Key Benefits Commercial	$3,745.44
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,602.21
Rate for Payer: Healthscope Commercial	$4,213.62
Rate for Payer: Mclaren Medicaid	$837.96
Rate for Payer: Mclaren Medicare	$1,602.21
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,682.32
Rate for Payer: Meridian Medicaid	$1,682.32
Rate for Payer: MI Amish Medical Board Commercial	$1,842.54
Rate for Payer: Molina Medicare/Medicaid	$1,762.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,979.53
Rate for Payer: Nomi Health Commercial	$4,806.63
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,511.35
Rate for Payer: PACE Medicare	$1,522.10
Rate for Payer: PACE SWMI	$1,602.21
Rate for Payer: PHP Commercial	$3,979.53
Rate for Payer: PHP Medicare Advantage	$1,602.21
Rate for Payer: Priority Health Choice Medicaid	$837.96
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$5,181.40
Rate for Payer: Priority Health Medicare	$1,602.21
Rate for Payer: Priority Health SBD	$2,949.53
Rate for Payer: Priority Health Tiered Network	$4,145.12
Rate for Payer: Railroad Medicare Medicare	$1,602.21
Rate for Payer: UHC All Payor (Choice/PPO)	$3,043.17
Rate for Payer: UHC Core	$2,439.22
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$1,602.21
Rate for Payer: UHC Exchange	$1,839.95
Rate for Payer: UHC Medicaid	$837.96
Rate for Payer: UHCCP Medicaid	$837.96
Rate for Payer: VA VA	$1,602.21

HC TENOTOMY PERCUTANEOUS SINGLE EACH DIGIT

Facility

$4,681.80

Service Code	CPT 26060
Hospital Charge Code	76100424
Hospital Revenue Code	761
Min. Negotiated Rate	$2,949.53
Max. Negotiated Rate	$4,213.62
Rate for Payer: Aetna Commercial	$3,979.53
Rate for Payer: Aetna New Business (MI Preferred)	$3,043.17
Rate for Payer: Cash Price	$3,745.44
Rate for Payer: Cofinity Advantage	$3,277.26
Rate for Payer: Cofinity Commercial	$4,026.35
Rate for Payer: Encore Health Key Benefits Commercial	$3,745.44
Rate for Payer: Healthscope Commercial	$4,213.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,979.53
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,511.35
Rate for Payer: PHP Commercial	$3,979.53
Rate for Payer: Priority Health SBD	$2,949.53

HC TENOTOMY SHOULDER AREA SINGLE TENDON

Facility

$4,922.84

Hospital Charge Code	36000098
Hospital Revenue Code	360
Min. Negotiated Rate	$3,101.39
Max. Negotiated Rate	$4,430.56
Rate for Payer: Aetna Commercial	$4,184.41
Rate for Payer: Aetna New Business (MI Preferred)	$3,199.85
Rate for Payer: Cash Price	$3,938.27
Rate for Payer: Cofinity Advantage	$3,445.99
Rate for Payer: Cofinity Commercial	$4,233.64
Rate for Payer: Encore Health Key Benefits Commercial	$3,938.27
Rate for Payer: Healthscope Commercial	$4,430.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,184.41
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,692.13
Rate for Payer: PHP Commercial	$4,184.41
Rate for Payer: Priority Health SBD	$3,101.39

HC TENOTOMY SHOULDER AREA SINGLE TENDON

Facility

$4,922.84

Hospital Charge Code	36000098
Hospital Revenue Code	360
Min. Negotiated Rate	$1,969.14
Max. Negotiated Rate	$4,430.56
Rate for Payer: Aetna Commercial	$4,184.41
Rate for Payer: Aetna Medicare	$2,461.42
Rate for Payer: Aetna New Business (MI Preferred)	$3,199.85
Rate for Payer: BCBS Complete	$1,969.14
Rate for Payer: Cash Price	$3,938.27
Rate for Payer: Cofinity Advantage	$3,445.99
Rate for Payer: Cofinity Commercial	$4,233.64
Rate for Payer: Encore Health Key Benefits Commercial	$3,938.27
Rate for Payer: Healthscope Commercial	$4,430.56
Rate for Payer: MI Amish Medical Board Commercial	$3,938.27
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,184.41
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,692.13
Rate for Payer: PHP Commercial	$4,184.41
Rate for Payer: Priority Health SBD	$3,101.39

HC TENOTOMY TOE SINGLE TENDON

Facility

$2,263.53

Service Code	CPT 28010
Hospital Charge Code	45000092
Hospital Revenue Code	761
Min. Negotiated Rate	$1,426.02
Max. Negotiated Rate	$2,037.18
Rate for Payer: Aetna Commercial	$1,924.00
Rate for Payer: Aetna New Business (MI Preferred)	$1,471.29
Rate for Payer: Cash Price	$1,810.82
Rate for Payer: Cofinity Advantage	$1,584.47
Rate for Payer: Cofinity Commercial	$1,946.64
Rate for Payer: Encore Health Key Benefits Commercial	$1,810.82
Rate for Payer: Healthscope Commercial	$2,037.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,924.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,697.65
Rate for Payer: PHP Commercial	$1,924.00
Rate for Payer: Priority Health SBD	$1,426.02

HC TENOTOMY TOE SINGLE TENDON

Facility

$2,263.53

Service Code	CPT 28010
Hospital Charge Code	45000092
Hospital Revenue Code	761
Min. Negotiated Rate	$120.43
Max. Negotiated Rate	$5,181.40
Rate for Payer: Aetna Commercial	$1,924.00
Rate for Payer: Aetna Medicare	$1,666.30
Rate for Payer: Aetna New Business (MI Preferred)	$1,471.29
Rate for Payer: Allen County Amish Medical Aid Commercial	$2,002.76
Rate for Payer: Amish Plain Church Group Commercial	$2,002.76
Rate for Payer: BCBS Complete	$879.93
Rate for Payer: BCBS MAPPO	$1,602.21
Rate for Payer: BCBS Trust/PPO	$120.43
Rate for Payer: BCN Commercial	$120.43
Rate for Payer: BCN Medicare Advantage	$1,602.21
Rate for Payer: Cash Price	$1,810.82
Rate for Payer: Cash Price	$1,810.82
Rate for Payer: Cash Price	$1,810.82
Rate for Payer: Cofinity Advantage	$1,584.47
Rate for Payer: Cofinity Commercial	$1,946.64
Rate for Payer: Encore Health Key Benefits Commercial	$1,810.82
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,602.21
Rate for Payer: Healthscope Commercial	$2,037.18
Rate for Payer: Mclaren Medicaid	$837.96
Rate for Payer: Mclaren Medicare	$1,602.21
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,682.32
Rate for Payer: Meridian Medicaid	$1,682.32
Rate for Payer: MI Amish Medical Board Commercial	$1,842.54
Rate for Payer: Molina Medicare/Medicaid	$1,762.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,924.00
Rate for Payer: Nomi Health Commercial	$4,806.63
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,697.65
Rate for Payer: PACE Medicare	$1,522.10
Rate for Payer: PACE SWMI	$1,602.21
Rate for Payer: PHP Commercial	$1,924.00
Rate for Payer: PHP Medicare Advantage	$1,602.21
Rate for Payer: Priority Health Choice Medicaid	$837.96
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$5,181.40
Rate for Payer: Priority Health Medicare	$1,602.21
Rate for Payer: Priority Health SBD	$1,426.02
Rate for Payer: Priority Health Tiered Network	$4,145.12
Rate for Payer: Railroad Medicare Medicare	$1,602.21
Rate for Payer: UHC All Payor (Choice/PPO)	$1,471.29
Rate for Payer: UHC Core	$1,179.30
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$1,602.21
Rate for Payer: UHC Exchange	$889.57
Rate for Payer: UHC Medicaid	$837.96
Rate for Payer: UHCCP Medicaid	$837.96
Rate for Payer: VA VA	$1,602.21

HC TESTOSTERONE BIOAVAILABLE

Facility

$79.59

Service Code	CPT 84402
Hospital Charge Code	30100429
Hospital Revenue Code	301
Min. Negotiated Rate	$50.14
Max. Negotiated Rate	$71.63
Rate for Payer: Aetna Commercial	$67.65
Rate for Payer: Aetna New Business (MI Preferred)	$51.73
Rate for Payer: Cash Price	$63.67
Rate for Payer: Cofinity Advantage	$55.71
Rate for Payer: Cofinity Commercial	$68.45
Rate for Payer: Encore Health Key Benefits Commercial	$63.67
Rate for Payer: Healthscope Commercial	$71.63
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$67.65
Rate for Payer: Opus (Opus Packaging Group) HMA	$59.69
Rate for Payer: PHP Commercial	$67.65
Rate for Payer: Priority Health SBD	$50.14

HC TESTOSTERONE BIOAVAILABLE

Facility

$79.59

Service Code	CPT 84402
Hospital Charge Code	30100429
Hospital Revenue Code	301
Min. Negotiated Rate	$13.32
Max. Negotiated Rate	$71.63
Rate for Payer: Aetna Commercial	$67.65
Rate for Payer: Aetna Medicare	$26.49
Rate for Payer: Aetna New Business (MI Preferred)	$51.73
Rate for Payer: Allen County Amish Medical Aid Commercial	$31.84
Rate for Payer: Amish Plain Church Group Commercial	$31.84
Rate for Payer: BCBS Complete	$13.99
Rate for Payer: BCBS MAPPO	$25.47
Rate for Payer: BCBS Trust/PPO	$27.15
Rate for Payer: BCN Commercial	$27.15
Rate for Payer: BCN Medicare Advantage	$25.47
Rate for Payer: Cash Price	$63.67
Rate for Payer: Cash Price	$63.67
Rate for Payer: Cofinity Advantage	$55.71
Rate for Payer: Cofinity Commercial	$68.45
Rate for Payer: Encore Health Key Benefits Commercial	$63.67
Rate for Payer: Health Alliance Plan Medicare Advantage	$25.47
Rate for Payer: Healthscope Commercial	$71.63
Rate for Payer: Mclaren Medicaid	$13.32
Rate for Payer: Mclaren Medicare	$25.47
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$26.74
Rate for Payer: Meridian Medicaid	$26.74
Rate for Payer: MI Amish Medical Board Commercial	$29.29
Rate for Payer: Molina Medicare/Medicaid	$28.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$67.65
Rate for Payer: Nomi Health Commercial	$38.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$59.69
Rate for Payer: PACE Medicare	$24.20
Rate for Payer: PACE SWMI	$25.47
Rate for Payer: PHP Commercial	$67.65
Rate for Payer: PHP Medicare Advantage	$25.47
Rate for Payer: Priority Health Choice Medicaid	$13.32
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$25.47
Rate for Payer: Priority Health Medicare	$25.47
Rate for Payer: Priority Health SBD	$50.14
Rate for Payer: Priority Health Tiered Network	$20.38
Rate for Payer: Railroad Medicare Medicare	$25.47
Rate for Payer: UHC All Payor (Choice/PPO)	$38.21
Rate for Payer: UHC Core	$38.21
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$25.47
Rate for Payer: UHC Exchange	$38.21
Rate for Payer: UHC Medicaid	$13.32
Rate for Payer: UHCCP Medicaid	$13.32
Rate for Payer: VA VA	$25.47

HC TESTOSTERONE FREE

Facility

$45.59

Service Code	CPT 84402
Hospital Charge Code	30100428
Hospital Revenue Code	301
Min. Negotiated Rate	$13.32
Max. Negotiated Rate	$41.03
Rate for Payer: Aetna Commercial	$38.75
Rate for Payer: Aetna Medicare	$26.49
Rate for Payer: Aetna New Business (MI Preferred)	$29.63
Rate for Payer: Allen County Amish Medical Aid Commercial	$31.84
Rate for Payer: Amish Plain Church Group Commercial	$31.84
Rate for Payer: BCBS Complete	$13.99
Rate for Payer: BCBS MAPPO	$25.47
Rate for Payer: BCBS Trust/PPO	$27.15
Rate for Payer: BCN Commercial	$27.15
Rate for Payer: BCN Medicare Advantage	$25.47
Rate for Payer: Cash Price	$36.47
Rate for Payer: Cash Price	$36.47
Rate for Payer: Cofinity Advantage	$31.91
Rate for Payer: Cofinity Commercial	$39.21
Rate for Payer: Encore Health Key Benefits Commercial	$36.47
Rate for Payer: Health Alliance Plan Medicare Advantage	$25.47
Rate for Payer: Healthscope Commercial	$41.03
Rate for Payer: Mclaren Medicaid	$13.32
Rate for Payer: Mclaren Medicare	$25.47
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$26.74
Rate for Payer: Meridian Medicaid	$26.74
Rate for Payer: MI Amish Medical Board Commercial	$29.29
Rate for Payer: Molina Medicare/Medicaid	$28.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$38.75
Rate for Payer: Nomi Health Commercial	$38.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$34.19
Rate for Payer: PACE Medicare	$24.20
Rate for Payer: PACE SWMI	$25.47
Rate for Payer: PHP Commercial	$38.75
Rate for Payer: PHP Medicare Advantage	$25.47
Rate for Payer: Priority Health Choice Medicaid	$13.32
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$25.47
Rate for Payer: Priority Health Medicare	$25.47
Rate for Payer: Priority Health SBD	$28.72
Rate for Payer: Priority Health Tiered Network	$20.38
Rate for Payer: Railroad Medicare Medicare	$25.47
Rate for Payer: UHC All Payor (Choice/PPO)	$38.21
Rate for Payer: UHC Core	$38.21
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$25.47
Rate for Payer: UHC Exchange	$38.21
Rate for Payer: UHC Medicaid	$13.32
Rate for Payer: UHCCP Medicaid	$13.32
Rate for Payer: VA VA	$25.47

HC TESTOSTERONE FREE

Facility

$45.59

Service Code	CPT 84402
Hospital Charge Code	30100428
Hospital Revenue Code	301
Min. Negotiated Rate	$28.72
Max. Negotiated Rate	$41.03
Rate for Payer: Healthscope Commercial	$41.03
Rate for Payer: Aetna Commercial	$38.75
Rate for Payer: Aetna New Business (MI Preferred)	$29.63
Rate for Payer: Cash Price	$36.47
Rate for Payer: Cofinity Advantage	$31.91
Rate for Payer: Cofinity Commercial	$39.21
Rate for Payer: Encore Health Key Benefits Commercial	$36.47
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$38.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$34.19
Rate for Payer: PHP Commercial	$38.75
Rate for Payer: Priority Health SBD	$28.72

HC TESTOSTERONE, FREE & WKLY BOUND

Facility

$83.23

Service Code	CPT 84410
Hospital Charge Code	30100736
Hospital Revenue Code	301
Min. Negotiated Rate	$52.43
Max. Negotiated Rate	$74.91
Rate for Payer: Aetna Commercial	$70.75
Rate for Payer: Aetna New Business (MI Preferred)	$54.10
Rate for Payer: Cash Price	$66.58
Rate for Payer: Cofinity Advantage	$58.26
Rate for Payer: Cofinity Commercial	$71.58
Rate for Payer: Encore Health Key Benefits Commercial	$66.58
Rate for Payer: Healthscope Commercial	$74.91
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$70.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$62.42
Rate for Payer: PHP Commercial	$70.75
Rate for Payer: Priority Health SBD	$52.43

HC TESTOSTERONE, FREE & WKLY BOUND

Facility

$83.23

Service Code	CPT 84410
Hospital Charge Code	30100736
Hospital Revenue Code	301
Min. Negotiated Rate	$26.82
Max. Negotiated Rate	$76.92
Rate for Payer: Aetna Commercial	$70.75
Rate for Payer: Aetna Medicare	$53.33
Rate for Payer: Aetna New Business (MI Preferred)	$54.10
Rate for Payer: Allen County Amish Medical Aid Commercial	$64.10
Rate for Payer: Amish Plain Church Group Commercial	$64.10
Rate for Payer: BCBS Complete	$28.16
Rate for Payer: BCBS MAPPO	$51.28
Rate for Payer: BCBS Trust/PPO	$54.67
Rate for Payer: BCN Commercial	$54.67
Rate for Payer: BCN Medicare Advantage	$51.28
Rate for Payer: Cash Price	$66.58
Rate for Payer: Cash Price	$66.58
Rate for Payer: Cofinity Advantage	$58.26
Rate for Payer: Cofinity Commercial	$71.58
Rate for Payer: Encore Health Key Benefits Commercial	$66.58
Rate for Payer: Health Alliance Plan Medicare Advantage	$51.28
Rate for Payer: Healthscope Commercial	$74.91
Rate for Payer: Mclaren Medicaid	$26.82
Rate for Payer: Mclaren Medicare	$51.28
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$53.84
Rate for Payer: Meridian Medicaid	$53.84
Rate for Payer: MI Amish Medical Board Commercial	$58.97
Rate for Payer: Molina Medicare/Medicaid	$56.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$70.75
Rate for Payer: Nomi Health Commercial	$76.92
Rate for Payer: Opus (Opus Packaging Group) HMA	$62.42
Rate for Payer: PACE Medicare	$48.72
Rate for Payer: PACE SWMI	$51.28
Rate for Payer: PHP Commercial	$70.75
Rate for Payer: PHP Medicare Advantage	$51.28
Rate for Payer: Priority Health Choice Medicaid	$26.82
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$51.28
Rate for Payer: Priority Health Medicare	$51.28
Rate for Payer: Priority Health SBD	$52.43
Rate for Payer: Priority Health Tiered Network	$41.02
Rate for Payer: Railroad Medicare Medicare	$51.28
Rate for Payer: UHC All Payor (Choice/PPO)	$76.92
Rate for Payer: UHC Core	$76.92
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$51.28
Rate for Payer: UHC Exchange	$76.92
Rate for Payer: UHC Medicaid	$26.82
Rate for Payer: UHCCP Medicaid	$26.82
Rate for Payer: VA VA	$51.28

HC TESTOSTERONE LEVEL

Facility

$88.57

Service Code	CPT 84403
Hospital Charge Code	30100430
Hospital Revenue Code	301
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$79.71
Rate for Payer: Aetna Commercial	$75.28
Rate for Payer: Aetna Medicare	$26.84
Rate for Payer: Aetna New Business (MI Preferred)	$57.57
Rate for Payer: Allen County Amish Medical Aid Commercial	$32.26
Rate for Payer: Amish Plain Church Group Commercial	$32.26
Rate for Payer: BCBS Complete	$14.17
Rate for Payer: BCBS MAPPO	$25.81
Rate for Payer: BCBS Trust/PPO	$27.52
Rate for Payer: BCN Commercial	$27.52
Rate for Payer: BCN Medicare Advantage	$25.81
Rate for Payer: Cash Price	$70.86
Rate for Payer: Cash Price	$70.86
Rate for Payer: Cofinity Advantage	$62.00
Rate for Payer: Cofinity Commercial	$76.17
Rate for Payer: Encore Health Key Benefits Commercial	$70.86
Rate for Payer: Health Alliance Plan Medicare Advantage	$25.81
Rate for Payer: Healthscope Commercial	$79.71
Rate for Payer: Mclaren Medicaid	$13.50
Rate for Payer: Mclaren Medicare	$25.81
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$27.10
Rate for Payer: Meridian Medicaid	$27.10
Rate for Payer: MI Amish Medical Board Commercial	$29.68
Rate for Payer: Molina Medicare/Medicaid	$28.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$75.28
Rate for Payer: Nomi Health Commercial	$38.72
Rate for Payer: Opus (Opus Packaging Group) HMA	$66.43
Rate for Payer: PACE Medicare	$24.52
Rate for Payer: PACE SWMI	$25.81
Rate for Payer: PHP Commercial	$75.28
Rate for Payer: PHP Medicare Advantage	$25.81
Rate for Payer: Priority Health Choice Medicaid	$13.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$25.81
Rate for Payer: Priority Health Medicare	$25.81
Rate for Payer: Priority Health SBD	$55.80
Rate for Payer: Priority Health Tiered Network	$20.65
Rate for Payer: Railroad Medicare Medicare	$25.81
Rate for Payer: UHC All Payor (Choice/PPO)	$38.72
Rate for Payer: UHC Core	$38.72
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$25.81
Rate for Payer: UHC Exchange	$38.72
Rate for Payer: UHC Medicaid	$13.50
Rate for Payer: UHCCP Medicaid	$13.50
Rate for Payer: VA VA	$25.81

HC TESTOSTERONE LEVEL

Facility

$88.57

Service Code	CPT 84403
Hospital Charge Code	30100430
Hospital Revenue Code	301
Min. Negotiated Rate	$55.80
Max. Negotiated Rate	$79.71
Rate for Payer: Aetna Commercial	$75.28
Rate for Payer: Aetna New Business (MI Preferred)	$57.57
Rate for Payer: Cash Price	$70.86
Rate for Payer: Cofinity Advantage	$62.00
Rate for Payer: Cofinity Commercial	$76.17
Rate for Payer: Encore Health Key Benefits Commercial	$70.86
Rate for Payer: Healthscope Commercial	$79.71
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$75.28
Rate for Payer: Opus (Opus Packaging Group) HMA	$66.43
Rate for Payer: PHP Commercial	$75.28
Rate for Payer: Priority Health SBD	$55.80

HC TESTOSTERONE LEVEL TOTAL

Facility

$95.51

Service Code	CPT 84403
Hospital Charge Code	30100431
Hospital Revenue Code	301
Min. Negotiated Rate	$60.17
Max. Negotiated Rate	$85.96
Rate for Payer: Aetna Commercial	$81.18
Rate for Payer: Aetna New Business (MI Preferred)	$62.08
Rate for Payer: Cash Price	$76.41
Rate for Payer: Cofinity Advantage	$66.86
Rate for Payer: Cofinity Commercial	$82.14
Rate for Payer: Encore Health Key Benefits Commercial	$76.41
Rate for Payer: Healthscope Commercial	$85.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$81.18
Rate for Payer: Opus (Opus Packaging Group) HMA	$71.63
Rate for Payer: PHP Commercial	$81.18
Rate for Payer: Priority Health SBD	$60.17

HC TESTOSTERONE LEVEL TOTAL

Facility

$95.51

Service Code	CPT 84403
Hospital Charge Code	30100431
Hospital Revenue Code	301
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$85.96
Rate for Payer: Aetna Commercial	$81.18
Rate for Payer: Aetna Medicare	$26.84
Rate for Payer: Aetna New Business (MI Preferred)	$62.08
Rate for Payer: Allen County Amish Medical Aid Commercial	$32.26
Rate for Payer: Amish Plain Church Group Commercial	$32.26
Rate for Payer: BCBS Complete	$14.17
Rate for Payer: BCBS MAPPO	$25.81
Rate for Payer: BCBS Trust/PPO	$27.52
Rate for Payer: BCN Commercial	$27.52
Rate for Payer: BCN Medicare Advantage	$25.81
Rate for Payer: Cash Price	$76.41
Rate for Payer: Cash Price	$76.41
Rate for Payer: Cofinity Advantage	$66.86
Rate for Payer: Cofinity Commercial	$82.14
Rate for Payer: Encore Health Key Benefits Commercial	$76.41
Rate for Payer: Health Alliance Plan Medicare Advantage	$25.81
Rate for Payer: Healthscope Commercial	$85.96
Rate for Payer: Mclaren Medicaid	$13.50
Rate for Payer: Mclaren Medicare	$25.81
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$27.10
Rate for Payer: Meridian Medicaid	$27.10
Rate for Payer: MI Amish Medical Board Commercial	$29.68
Rate for Payer: Molina Medicare/Medicaid	$28.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$81.18
Rate for Payer: Nomi Health Commercial	$38.72
Rate for Payer: Opus (Opus Packaging Group) HMA	$71.63
Rate for Payer: PACE Medicare	$24.52
Rate for Payer: PACE SWMI	$25.81
Rate for Payer: PHP Commercial	$81.18
Rate for Payer: PHP Medicare Advantage	$25.81
Rate for Payer: Priority Health Choice Medicaid	$13.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$25.81
Rate for Payer: Priority Health Medicare	$25.81
Rate for Payer: Priority Health SBD	$60.17
Rate for Payer: Priority Health Tiered Network	$20.65
Rate for Payer: Railroad Medicare Medicare	$25.81
Rate for Payer: UHC All Payor (Choice/PPO)	$38.72
Rate for Payer: UHC Core	$38.72
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$25.81
Rate for Payer: UHC Exchange	$38.72
Rate for Payer: UHC Medicaid	$13.50
Rate for Payer: UHCCP Medicaid	$13.50
Rate for Payer: VA VA	$25.81

HC TESTOSTERONE PELLETS EACH

Facility

$229.22

Service Code	CPT J3490
Hospital Charge Code	63600196
Hospital Revenue Code	636
Min. Negotiated Rate	$91.69
Max. Negotiated Rate	$206.30
Rate for Payer: Aetna Commercial	$194.84
Rate for Payer: Aetna Medicare	$114.61
Rate for Payer: Aetna New Business (MI Preferred)	$148.99
Rate for Payer: BCBS Complete	$91.69
Rate for Payer: Cash Price	$183.38
Rate for Payer: Cofinity Advantage	$160.45
Rate for Payer: Cofinity Commercial	$197.13
Rate for Payer: Encore Health Key Benefits Commercial	$183.38
Rate for Payer: Healthscope Commercial	$206.30
Rate for Payer: MI Amish Medical Board Commercial	$183.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$194.84
Rate for Payer: Opus (Opus Packaging Group) HMA	$171.91
Rate for Payer: PHP Commercial	$194.84
Rate for Payer: Priority Health SBD	$144.41

HC TESTOSTERONE PELLETS EACH

Facility

$229.22

Service Code	CPT J3490
Hospital Charge Code	63600196
Hospital Revenue Code	636
Min. Negotiated Rate	$144.41
Max. Negotiated Rate	$206.30
Rate for Payer: Aetna Commercial	$194.84
Rate for Payer: Aetna New Business (MI Preferred)	$148.99
Rate for Payer: Cash Price	$183.38
Rate for Payer: Cofinity Advantage	$160.45
Rate for Payer: Cofinity Commercial	$197.13
Rate for Payer: Encore Health Key Benefits Commercial	$183.38
Rate for Payer: Healthscope Commercial	$206.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$194.84
Rate for Payer: Opus (Opus Packaging Group) HMA	$171.91
Rate for Payer: PHP Commercial	$194.84
Rate for Payer: Priority Health SBD	$144.41

HC TESTOSTERONE, T, BIO, FREE

Facility

$82.77

Service Code	CPT 84403
Hospital Charge Code	30100608
Hospital Revenue Code	301
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$74.49
Rate for Payer: Aetna Commercial	$70.35
Rate for Payer: Aetna Medicare	$26.84
Rate for Payer: Aetna New Business (MI Preferred)	$53.80
Rate for Payer: Allen County Amish Medical Aid Commercial	$32.26
Rate for Payer: Amish Plain Church Group Commercial	$32.26
Rate for Payer: BCBS Complete	$14.17
Rate for Payer: BCBS MAPPO	$25.81
Rate for Payer: BCBS Trust/PPO	$27.52
Rate for Payer: BCN Commercial	$27.52
Rate for Payer: BCN Medicare Advantage	$25.81
Rate for Payer: Cash Price	$66.22
Rate for Payer: Cash Price	$66.22
Rate for Payer: Cofinity Advantage	$57.94
Rate for Payer: Cofinity Commercial	$71.18
Rate for Payer: Encore Health Key Benefits Commercial	$66.22
Rate for Payer: Health Alliance Plan Medicare Advantage	$25.81
Rate for Payer: Healthscope Commercial	$74.49
Rate for Payer: Mclaren Medicaid	$13.50
Rate for Payer: Mclaren Medicare	$25.81
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$27.10
Rate for Payer: Meridian Medicaid	$27.10
Rate for Payer: MI Amish Medical Board Commercial	$29.68
Rate for Payer: Molina Medicare/Medicaid	$28.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$70.35
Rate for Payer: Nomi Health Commercial	$38.72
Rate for Payer: Opus (Opus Packaging Group) HMA	$62.08
Rate for Payer: PACE Medicare	$24.52
Rate for Payer: PACE SWMI	$25.81
Rate for Payer: PHP Commercial	$70.35
Rate for Payer: PHP Medicare Advantage	$25.81
Rate for Payer: Priority Health Choice Medicaid	$13.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$25.81
Rate for Payer: Priority Health Medicare	$25.81
Rate for Payer: Priority Health SBD	$52.15
Rate for Payer: Priority Health Tiered Network	$20.65
Rate for Payer: Railroad Medicare Medicare	$25.81
Rate for Payer: UHC All Payor (Choice/PPO)	$38.72
Rate for Payer: UHC Core	$38.72
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$25.81
Rate for Payer: UHC Exchange	$38.72
Rate for Payer: UHC Medicaid	$13.50
Rate for Payer: UHCCP Medicaid	$13.50
Rate for Payer: VA VA	$25.81

HC TESTOSTERONE, T, BIO, FREE

Facility

$82.77

Service Code	CPT 84403
Hospital Charge Code	30100608
Hospital Revenue Code	301
Min. Negotiated Rate	$52.15
Max. Negotiated Rate	$74.49
Rate for Payer: Aetna Commercial	$70.35
Rate for Payer: Aetna New Business (MI Preferred)	$53.80
Rate for Payer: Cash Price	$66.22
Rate for Payer: Cofinity Advantage	$57.94
Rate for Payer: Cofinity Commercial	$71.18
Rate for Payer: Encore Health Key Benefits Commercial	$66.22
Rate for Payer: Healthscope Commercial	$74.49
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$70.35
Rate for Payer: Opus (Opus Packaging Group) HMA	$62.08
Rate for Payer: PHP Commercial	$70.35
Rate for Payer: Priority Health SBD	$52.15

HC TESTOSTERONE UNDECANOATE PER 1 MG

Facility

$5.20

Service Code	HCPCS J3145
Hospital Charge Code	63600155
Hospital Revenue Code	636
Min. Negotiated Rate	$3.28
Max. Negotiated Rate	$4.68
Rate for Payer: Aetna Commercial	$4.42
Rate for Payer: Aetna New Business (MI Preferred)	$3.38
Rate for Payer: Cash Price	$4.16
Rate for Payer: Cofinity Advantage	$3.64
Rate for Payer: Cofinity Commercial	$4.47
Rate for Payer: Encore Health Key Benefits Commercial	$4.16
Rate for Payer: Healthscope Commercial	$4.68
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.42
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.90
Rate for Payer: PHP Commercial	$4.42
Rate for Payer: Priority Health SBD	$3.28

HC TESTOSTERONE UNDECANOATE PER 1 MG

Facility

$5.20

Service Code	HCPCS J3145
Hospital Charge Code	63600155
Hospital Revenue Code	636
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$6.52
Rate for Payer: Aetna Commercial	$4.42
Rate for Payer: Aetna Medicare	$2.22
Rate for Payer: Aetna New Business (MI Preferred)	$3.38
Rate for Payer: Allen County Amish Medical Aid Commercial	$2.66
Rate for Payer: Amish Plain Church Group Commercial	$2.66
Rate for Payer: BCBS Complete	$1.17
Rate for Payer: BCBS MAPPO	$2.13
Rate for Payer: BCBS Trust/PPO	$5.17
Rate for Payer: BCN Commercial	$5.17
Rate for Payer: BCN Medicare Advantage	$2.13
Rate for Payer: Cash Price	$4.16
Rate for Payer: Cash Price	$4.16
Rate for Payer: Cofinity Advantage	$3.64
Rate for Payer: Cofinity Commercial	$4.47
Rate for Payer: Encore Health Key Benefits Commercial	$4.16
Rate for Payer: Health Alliance Plan Medicare Advantage	$2.13
Rate for Payer: Healthscope Commercial	$4.68
Rate for Payer: Mclaren Medicaid	$1.11
Rate for Payer: Mclaren Medicare	$2.13
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$2.24
Rate for Payer: Meridian Medicaid	$2.24
Rate for Payer: MI Amish Medical Board Commercial	$2.45
Rate for Payer: Molina Medicare/Medicaid	$2.34
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.42
Rate for Payer: Nomi Health Commercial	$6.39
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.90
Rate for Payer: PACE Medicare	$2.02
Rate for Payer: PACE SWMI	$2.13
Rate for Payer: PHP Commercial	$4.42
Rate for Payer: PHP Medicare Advantage	$2.13
Rate for Payer: Priority Health Choice Medicaid	$1.11
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$6.52
Rate for Payer: Priority Health Medicare	$2.13
Rate for Payer: Priority Health SBD	$3.28
Rate for Payer: Priority Health Tiered Network	$5.22
Rate for Payer: Railroad Medicare Medicare	$2.13
Rate for Payer: UHC All Payor (Choice/PPO)	$3.42
Rate for Payer: UHC Core	$3.42
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$2.13
Rate for Payer: UHC Exchange	$3.42
Rate for Payer: UHC Medicaid	$1.11
Rate for Payer: UHCCP Medicaid	$1.11
Rate for Payer: VA VA	$2.13

HC TESTOSTERONE UNLISTED CHEMISTRY

Facility

$91.80

Service Code	CPT 84410
Hospital Charge Code	30100642
Hospital Revenue Code	301
Min. Negotiated Rate	$26.82
Max. Negotiated Rate	$82.62
Rate for Payer: Aetna Commercial	$78.03
Rate for Payer: Aetna Medicare	$53.33
Rate for Payer: Aetna New Business (MI Preferred)	$59.67
Rate for Payer: Allen County Amish Medical Aid Commercial	$64.10
Rate for Payer: Amish Plain Church Group Commercial	$64.10
Rate for Payer: BCBS Complete	$28.16
Rate for Payer: BCBS MAPPO	$51.28
Rate for Payer: BCBS Trust/PPO	$54.67
Rate for Payer: BCN Commercial	$54.67
Rate for Payer: BCN Medicare Advantage	$51.28
Rate for Payer: Cash Price	$73.44
Rate for Payer: Cash Price	$73.44
Rate for Payer: Cofinity Advantage	$64.26
Rate for Payer: Cofinity Commercial	$78.95
Rate for Payer: Encore Health Key Benefits Commercial	$73.44
Rate for Payer: Health Alliance Plan Medicare Advantage	$51.28
Rate for Payer: Healthscope Commercial	$82.62
Rate for Payer: Mclaren Medicaid	$26.82
Rate for Payer: Mclaren Medicare	$51.28
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$53.84
Rate for Payer: Meridian Medicaid	$53.84
Rate for Payer: MI Amish Medical Board Commercial	$58.97
Rate for Payer: Molina Medicare/Medicaid	$56.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$78.03
Rate for Payer: Nomi Health Commercial	$76.92
Rate for Payer: Opus (Opus Packaging Group) HMA	$68.85
Rate for Payer: PACE Medicare	$48.72
Rate for Payer: PACE SWMI	$51.28
Rate for Payer: PHP Commercial	$78.03
Rate for Payer: PHP Medicare Advantage	$51.28
Rate for Payer: Priority Health Choice Medicaid	$26.82
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$51.28
Rate for Payer: Priority Health Medicare	$51.28
Rate for Payer: Priority Health SBD	$57.83
Rate for Payer: Priority Health Tiered Network	$41.02
Rate for Payer: Railroad Medicare Medicare	$51.28
Rate for Payer: UHC All Payor (Choice/PPO)	$76.92
Rate for Payer: UHC Core	$76.92
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$51.28
Rate for Payer: UHC Exchange	$76.92
Rate for Payer: UHC Medicaid	$26.82
Rate for Payer: UHCCP Medicaid	$26.82
Rate for Payer: VA VA	$51.28

Know your out-of-pocket cost for care.

All Charges